Friday, March 12, 2010

HCR Updates

This won't be shocking to many of you, but the Congressional Budget Office just released an updated analysis for the Senate health-care bill, and it finds that it reduces the deficit, much as its predecessors did. The first 10 years see savings of $118 billion, and the second 10 years see savings in excess of $600 billion. Most striking is that "CBO expects that the legislation would generate a reduction in the federal budgetary commitment to health care during the decade following 2019," which is to say that this bill will cover 30 million people but the cost controls will, within a decade or so, leave us spending less on health care than if we'd done nothing.

That's a pretty good deal.

But it's not a very well-understood deal. In their Wall Street Journal op-ed, pollsters Scott Rasmussen and Doug Schoen observed that "people simply don't trust the official projections. People in Washington may live and die by the pronouncements of the Congressional Budget Office, but 81% of voters say it's likely the plan will end up costing more than projected."

That's obvious enough. People understand the part of the bill that costs money: We're buying health-care insurance for folks who can't afford it themselves. They don't understand the parts of the bill that save money: We're taxing high-value benefits? We've got a Medicare Commission empowered to make unnamed reforms to the system? We're moving toward bundling for hospital payments in Medicare? And since few know about these policies, much less understand them, the projections that show the bill saving money don't make much sense, and so voters don't believe them.

Republican aides, reporting the decision, interpreted it to mean the House would have to clear the Senate bill and President Obama would have to sign it before the reconciliation bill could be passed. House leaders had been hoping that the two bills could be passed almost simultaneously.

The parliamentarian, however, later reportedly clarified his position to Senate aides, saying that the reconciliation bill could be written in a way that would not require Obama to sign the Senate bill into law before the reconciliation bill is voted on.

Thank you, and have a pleasant day.

If you don't have a CQ subscription, for now you'll have to settle for Politico's story:

[A]ccording to reporting by POLITICO’s David Rogers, the accounts aren’t accurate and misconstrue what the Senate parliamentarians have said. That is that reconciliation must amend law but this could be done without the Senate bill being enacted first. “It is wholly possible to create law and qualify law before the law is on the books,” said one person familiar with situation.

For example, if the big bill itself amends some Social Security statute, reconciliation could be written to do the same --with changes sought by the House. Then if reconciliation is passed and signed by President Barack Obama after he signs the larger bill, the changes made in reconciliation would prevail.This jives with what Pulse sources were saying soon after the first wave of stories hit – in essence, don’t take the reported parliamentarian’s declaration to the bank.

The White House recently began pushing a March 18 deadline for a House vote on health care reform for a specific reason: President Obama was scheduled to leave town.

The president was set to fly to Asia on the 18th, so he encouraged House leaders to wrap things up quickly, before he departs, so he would be available for 11th-hour appeals to lawmakers. The point was to make it easier for Obama to help the House leadership get to 216 before he left.

House Dems pushed back a bit, arguing that the 18th was unrealistic. As a result, the White House announced this morning that the president will delay his departure by a few days.

President Obama is delaying his trip to Indonesia, Guam and Australia next week, an administration official said Friday, so the White House can focus on passing health care legislation in the House. [...]

In fact, the president is no longer taking First Lady Michelle Obama and their two daughters on the trip, an administration official said. The president agreed to delay his departure from March 18 to March 21, an administration official said, shortening the trip for official business only in an effort to show flexibility in the final push on health care legislation. The three-day delay effectively sets a new timetable for the House vote on the measure.

So, is this good news or bad? I'm inclined to see it as a positive move. It gives Democratic leaders a little more breathing room, but still focuses the timeline. This also signals to the House -- the vote is coming, and the president is intent on making this push successful.

In case you're wondering, if there's a delay, and the votes don't materialize by Sunday the 21st, the president won't return to Washington until Friday the 26th.

Contra Marshall, I would not put much weight on tea leaves and second derivatives. For example.

That uptick in support for Obama over health care happened at about the same time that Obama personally stepped into the process (i.e., announed his summit). Note that Obama didn’t push any specific policy until two days before the summit on February 25. People apparently respect leaders who care about things and show some leadership in making them happen. If nothing else the Bush administration showed that Americans reward boldness and success more or less independently of what the new laws actually do. Bush freed the FBI to tap everyone’s phones and more than half the country went nuts with joy.

Whatever minor upswing Democrats might be riding right now, they’re riding it because they have grown a little fighting spirit. If they let health care die the country will turn on them for being losers. Most Democrats will take exactly the wrong lesson from that and compromise the rest of their agenda away, and Republicans will run roughshod over them until they win a majority back in November.

The situation now is as follows: * Whatever happens, must happen quickly or not at all. * Stances on healthcare reform have hardened significantly for nearly all legislators. * Whatever deals were going to be made, have basically already been made.

In short, the time for bluffing and negotiation is at an end. The final deal (Senate bill + reconciliation) is basically written in stone. Now the only question is whether that deal will pass, or not—and who will be allied with whom in that coming battle.

Exactly. Policy discussions are done. The House will put out its reconciliation bill as soon as Monday. The only question left is whether Democrats will grow the balls to save millions of uninsured Americans and their own jobs.

Today would be a good day to get to know your Reps’ staffers on a first-name basis.

Health reform is back from the dead. Many Democrats have realized that their electoral prospects will be better if they can point to a real accomplishment. Polling on reform — which was never as negative as portrayed — shows signs of improving. And I’ve been really impressed by the passion and energy of this guy Barack Obama. Where was he last year?

I dunno. Maybe expecting the Democratic majority in the legislature to write some legislation on the issue they have been trumpeting for five decades? I guess the fact Obama had some personal relationships with people from his time in the Senate blinded him to the simple fact that the vast majority of Democrats in congress are as worthless as breasts on men.

Also, only recently has the White House deployed the Rahm Emanuel Penis of Doom in the House showers, so who knows what else they have up their sleeves in their pants left?

I don’t know how anyone can look at the past year and not realize the problem in this government is in the Senate, and not the House or the White House.

Rep. Luis Gutierrez (D-IL) said on MSNBC yesterday that the immigration provisions in the health care bill "are enough to say I can't support this bill."

That would be a big blow to House Speaker Nancy Pelosi (D-CA). Gutierrez voted 'yes' on the House health care bill last year. Switching to 'no' on the Senate bill -- as Guitierrez suggested he would -- would take a key vote away from Pelosi as she tries to hang onto enough votes for the House to pass the Senate bill.

Guitierrez, who was heading to the White House after his interview with Chuck Todd, expressed displeasure that undocumented immigrants would be barred from buying health care on a new exchange. He also worried that the Senate wanted to exclude illegal permanent residents for the first five years.

Todd asked if those two issues were enough for Gutierrez to say he couldn't support the health care reform bill.

"They are enough to say I can't support this bill," the congressman said.

Health reform is back from the dead. Many Democrats have realized that their electoral prospects will be better if they can point to a real accomplishment. Polling on reform — which was never as negative as portrayed — shows signs of improving. And I’ve been really impressed by the passion and energy of this guy Barack Obama. Where was he last year?

But reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.

The first of these myths, which has been all over the airwaves lately, is the claim that President Obama is proposing a government takeover of one-sixth of the economy, the share of G.D.P. currently spent on health.

Well, if having the government regulate and subsidize health insurance is a “takeover,” that takeover happened long ago. Medicare, Medicaid, and other government programs already pay for almost half of American health care, while private insurance pays for barely more than a third (the rest is mostly out-of-pocket expenses). And the great bulk of that private insurance is provided via employee plans, which are both subsidized with tax exemptions and tightly regulated.

The only part of health care in which there isn’t already a lot of federal intervention is the market in which individuals who can’t get employment-based coverage buy their own insurance. And that market, in case you hadn’t noticed, is a disaster — no coverage for people with pre-existing medical conditions, coverage dropped when you get sick, and huge premium increases in the middle of an economic crisis. It’s this sector, plus the plight of Americans with no insurance at all, that reform aims to fix. What’s wrong with that?

The second myth is that the proposed reform does nothing to control costs. To support this claim, critics point to reports by the Medicare actuary, who predicts that total national health spending would be slightly higher in 2019 with reform than without it.

Even if this prediction were correct, it points to a pretty good bargain. The actuary’s assessment of the Senate bill, for example, finds that it would raise total health care spending by less than 1 percent, while extending coverage to 34 million Americans who would otherwise be uninsured. That’s a large expansion in coverage at an essentially trivial cost.

And it gets better as we go further into the future: the Congressional Budget Office has just concluded, in a new report, that the arithmetic of reform will look better in its second decade than it did in its first.

Furthermore, there’s good reason to believe that all such estimates are too pessimistic. There are many cost-saving efforts in the proposed reform, but nobody knows how well any one of these efforts will work. And as a result, official estimates don’t give the plan much credit for any of them. What the actuary and the budget office do is a bit like looking at an oil company’s prospecting efforts, concluding that any individual test hole it drills will probably come up dry, and predicting as a consequence that the company won’t find any oil at all — when the odds are, in fact, that some of the test holes will pan out, and produce big payoffs. Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.

Which brings me to the third myth: that health reform is fiscally irresponsible. How can people say this given Congressional Budget Office predictions — which, as I’ve already argued, are probably too pessimistic — that reform would actually reduce the deficit? Critics argue that we should ignore what’s actually in the legislation; when cost control actually starts to bite on Medicare, they insist, Congress will back down.

But this isn’t an argument against Obamacare, it’s a declaration that we can’t control Medicare costs no matter what. And it also flies in the face of history: contrary to legend, past efforts to limit Medicare spending have in fact “stuck,” rather than being withdrawn in the face of political pressure.

So what’s the reality of the proposed reform? Compared with the Platonic ideal of reform, Obamacare comes up short. If the votes were there, I would much prefer to see Medicare for all.

For a real piece of passable legislation, however, it looks very good. It wouldn’t transform our health care system; in fact, Americans whose jobs come with health coverage would see little effect. But it would make a huge difference to the less fortunate among us, even as it would do more to control costs than anything we’ve done before.

This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.

I've been a bit annoyed by the convention of referring to the health-care bill's 10-year cost rather than its annual cost. We don't talk about very much in terms of 10-year costs, and so people don't have much context for it. So I asked crack intern Dylan Matthews to build a crude comparison of what various government programs are projected to cost in 2015 (chosen because health-care reform doesn't kick off until 2014, and I wanted to give it a year to get up and running). Projections are always iffy, but this is just to get an idea of the relative size of different programs. Ready for it?

What you're seeing is health-care reform clocks in around $100 billion. Which is pretty small compared to the $600 billion going to defense, or the $700 billion going to Medicare, or the $900 billion going to Social Security. It's even small in comparison to the to the $250 billion going to subsidize employer-based health care and the $150 billion for the mortgage interest deduction -- both of which are massive tax breaks for people who are a lot better off than the beneficiaries of the health-care bill. That's the health-care proposal in context: Real money, but not the biggest bill on the planet.

I really think that political journalists who’ve spent more than 20 minutes over the past 24 hours covering the Eric Massa story need to turn the TV off, turn the BlackBerry off, turn the Twitter off, shut everything down, go to a nice quiet room, take a deep breath, look in the mirror and ask themselves why they got into this business.

How many reporters are covering this story? What are the odds that some important fact of Massa’s life will go unrevealed if you do not devote your talents and energies to looking into it? Isn’t it more likely that you’re going to commit useful journalism by looking into something else? Anything else? Like, literally, anything else? It seems to me that at the margin pretty much any use of a journalist’s time would have a greater social value than further Massa reporting. A nap, even. Get well-rested for tomorrow’s goofy story.

You can go too far talking about this in terms of individual journalists. Competitive pressures are competitive pressures, and individual journalists get assignments from their editors. But the point still stands.

I'd only add this: The indictment isn't that Massa turned out to be a nonstory. It would be much worse, in fact, if he'd been a "story." If he'd done more to attack the health-care bill, or offered specific stories of members of the House leadership doing terrible things like trying to add elements to the legislation in order to secure Massa's vote. That would've been a "big" story and no one would feel silly for covering it. But it actually would've been worse.

The media are so focused on the undecideds and unlikely opponents of the world -- the Dennis Kucinichs and Joe Liebermans -- that all the American people ever hear are these self-important chin-strokers hammering legislation. And when it's not them, it's the serious partisans: Members of the leadership and so forth. But it's not because these folks know the most about the legislation, or have the most informative take. It's because these people's statements are the most newsworthy because their votes are the most important.

But that means we center our coverage around the most egotistical and politically motivated legislators, and then we let them explain the substance of policy through their skewed and self-interested lenses. Of course, the people tuning into our shows or reading us don't know that we're doing this to get insight into these legislator's votes and that they should ignore the analysis, as it's coming from some of the least credible players in Congress.

Every couple of weeks, in between visits to a Pampered Chef outlet or the Iphone store or a wine party held by Cato or Reason, McMegan will belch out a post so silly and riddled with inaccuracies that some poor bastard like Tom Levenson or Susan of Texas will have to spend hours noting all the mistakes and absurdities.

Then, a few days later, after everyone has already had a laugh and the piece has been thoroughly debunked, Sullivan will then link to it and call it “interesting” or “provocative,” and we here will then have to field 5000 comments furiously asking why DougJ and I continue to read Sullivan (because I like his writing!).